Changes of trauma stress and micrometastasis after laparoscopic resection in patients with colon cancer

doi:10.3877/cma.j.issn.1674-0793.2018.05.011

Abstract

Abstract:

Objective

To compare the effects of laparoscopic colon resection on trauma stress and micrometastasis in patients with colon cancer.

Methods

From May 2011 to May 2016, a total of ninety-eight patients admitted to People’s Hospital of Tinghu District who were diagnosed with colon cancer were selected. According to the random number, they were divided into laparoscopic group (undergoing laparoscopic colon cancer resection) and laparotomy group (treated with traditional laparotomy), with 49 patients in each group, respectively. The concentration of white blood cell (WBC), neutrophil (N), C-reactive protein (CRP), cortisol (Cor) in peripheral blood, and carcinoembryonic antigen (CEA), dopa decarboxylase (DDC) concentration in peritoneal wash fluid were detected and compared.

Results

(1) The length of incision, operative time, intraoperative blood loss, hospitalization time, gastrointestinal function recovery time, postoperative ambulation time and postoperative exhaust time in laparoscopic group were all better than those in the laparotomy group (all P<0.05). The incidence of complications and recurrence rate in the laparoscopy group were significantly lower than those in the laparotomy group, and the survival rate was significantly higher (χ²=8.023, 4.638, 2.368, P=0.001, 0.002, 0.004). (2) There was no significant difference in the preoperative peripheral blood stress between the two groups, but it showed significant increase at the end of the operation. WBC, Cor, and N reached the highest value 1 d after operation, while CRP 3 d after operation. The concentration of Cor in peripheral blood at 0 and 1 d after operation in the laparoscopy group was significantly lower than that in the laparotomy group (P<0.05). The concentration of CRP in peripheral blood at 1 and 3 d after operation in the laparoscopy group was significantly lower than that in the laparotomy group (P<0.05). (3) The CEA and DDC concentration (μg/L) in the two groups showed no statistical significance differences (t=1.458, 1.024, P=0.446, 0.573). At the end of the operation, CEA and DDC concentration (μg/L) in the laparoscopic group were 1 495.8±657.4, 121.5±48.6 respectively, lower than 2 873.8±1 752.1, 165.7±58.7 in the laparotomy group obviously (t=2.861, 2.534, P=0.011, 0.012).

Conclusion

Laparoscopic resection of colon cancer can shorten the hospitalization time, and improve the therapeutic effect and the patients’ survival rate, with small trauma and lower probability of tumor micrometastasis.

Key words: Colonic neoplasms, Colectomy, Stress disorders, traumatic, Neoplasm metastasis

Peng Wang, Sanhui Zhan, Weihua Bai, Haiyang Yu. Changes of trauma stress and micrometastasis after laparoscopic resection in patients with colon cancer[J]. Chinese Archives of General Surgery(Electronic Edition), 2018, 12(05): 332-336.

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References 21

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组别	例数	年龄(岁, ±s)	男/女(例)	肿瘤直径(cm , ±s)	早期癌[例(%)]	进展期癌[例(%)]	病程(年, ±s)
腹腔镜组	49	66.6±10.1	27/22	2.1±0.5	21(42.9)	28(57.1)	1.07±0.8
开腹组	49	68.2±11.2	24/25	2.4±0.6	23(47.0)	26(53.0)	1.05±0.7
统计值	?	t=1.392	χ²=1.406	t=1.399	χ²=1.305	χ²=1.383	t=1.273
P值	?	0.968	0.998	0.982	0.716	0.853	0.663

组别	例数	年龄(岁, ±s)	男/女(例)	肿瘤直径(cm , ±s)	早期癌[例(%)]	进展期癌[例(%)]	病程(年, ±s)
腹腔镜组	49	66.6±10.1	27/22	2.1±0.5	21(42.9)	28(57.1)	1.07±0.8
开腹组	49	68.2±11.2	24/25	2.4±0.6	23(47.0)	26(53.0)	1.05±0.7
统计值	?	t=1.392	χ²=1.406	t=1.399	χ²=1.305	χ²=1.383	t=1.273
P值	?	0.968	0.998	0.982	0.716	0.853	0.663

组别	例数	手术时间(min)	切口长度(cm)	术中出血量(ml)	淋巴结清除个数(个)	术后排气时间(h)	术后下床活动时间(h)	肠胃功能恢复时间(d)	住院时间(d)	总并发症(%)	复发率(%)	生存率(%)
腹腔镜组	49	232.38±3.32	7.51±1.23	78.62±12.93	10.45±2.31	58.38±5.52	75.26±9.18	2.32±1.13	6.78±1.31	14.3	8.2	93.9
开腹组	49	299.58±7.26	13.85±2.31	187.42±33.54	11.02±2.42	85.85±8.79	103.21±17.56	7.62±0.98	12.54±1.87	30.6	24.5	79.6
统计值	?	5.362^a	3.386^a	3.121^a	1.356^a	4.236^a	4.896^a	6.212^a	5.387^a	8.023^b	4.638^b	2.368^b
P值	?	0.001	0.002	0.002	0.231	0.002	0.002	0.001	0.001	0.001	0.002	0.004

组别	例数	手术时间(min)	切口长度(cm)	术中出血量(ml)	淋巴结清除个数(个)	术后排气时间(h)	术后下床活动时间(h)	肠胃功能恢复时间(d)	住院时间(d)	总并发症(%)	复发率(%)	生存率(%)
腹腔镜组	49	232.38±3.32	7.51±1.23	78.62±12.93	10.45±2.31	58.38±5.52	75.26±9.18	2.32±1.13	6.78±1.31	14.3	8.2	93.9
开腹组	49	299.58±7.26	13.85±2.31	187.42±33.54	11.02±2.42	85.85±8.79	103.21±17.56	7.62±0.98	12.54±1.87	30.6	24.5	79.6
统计值	?	5.362^a	3.386^a	3.121^a	1.356^a	4.236^a	4.896^a	6.212^a	5.387^a	8.023^b	4.638^b	2.368^b
P值	?	0.001	0.002	0.002	0.231	0.002	0.002	0.001	0.001	0.001	0.002	0.004

组别	时间点	WBC（×10⁹/L）	Cor（μg/L）	N（%）	CRP（mg/L）
腹腔镜组（49例）	术前	5.65±1.61	385.6±134.4	58.9±9.4	7.1±5.2
?	术后0 d	7.81±2.63	186.9±157.6	80.4±9.2	7.6±6.2
?	术后1 d	11.15±3.38	445.8±189.6	86.4±5.3	93.7±36.2
?	术后3 d	9.57±3.56	408.5±190.1	81.4±6.1	140.5±62.1
?	术后7 d	8.24±3.05	409.6±124.6	71.4±8.5	57.6±34.2
开腹组（49例）	术前	5.72±1.52	401.3±167.8	59.7±9.3	7.2±5.1
?	术后0 d	7.79±2.49	243.6±174.9	81.1±9.3	8.1±7.3
?	术后1 d	11.63±3.46	512.5±194.3	87.3±6.1	108.9±46.5
?	术后3 d	9.46±3.47	423.5±128.9	82.2±6.2	184.3±70.3
?	术后7 d	8.31±2.96	411.8±134.2	72.1±8.7	62.4±38.7
t值^a	?	1.687, 1.699, 1.643, 1.823, 1.792	1.013, 1.853, 1.571, 1.237, 1.228	1.121, 1.764, 1.957, 1.355, 1.823	1.012, 1.563, 2.379, 3.562, 1.783
P值^a	?	0.468, 0.853, 0.716, 0.853, 0.998	0.683, 0.012, 0.022, 0.721, 0.885	0.866, 0.847, 0.923, 0.647, 0.876	0.934, 0.881, 0.023, 0.014, 0.889

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